- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,165.95 / $7,943.28 / $14,454.40
| Facility | | $6,165.95 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $3,311.31 / $16,982.44
| Professional | | $2,818.38 | $3,311.31 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,120.11 / $11,748.98 / $22,908.68
| Facility | | $9,120.11 | $11,748.98 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,691.53 / $4,570.88 / $6,165.95
| Professional | | $2,691.53 | $4,570.88 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,467.37 / $7,079.46 / $9,120.11
| Professional | | $3,467.37 | $7,079.46 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,818.38 / $4,786.30 / $45,708.82
| Facility | | $2,818.38 | $4,786.30 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $6,165.95 / $23,442.29
| Professional | | $3,715.35 | $6,165.95 | $23,442.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,918.31 / $7,244.36 / $10,232.93
| Professional | | $6,918.31 | $7,244.36 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,606.93 / $6,606.93 / $6,606.93
| Professional | | $6,606.93 | $6,606.93 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $4,365.16 / $8,317.64
| Professional | | $10.96 | $4,365.16 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $4,466.84 / $8,128.31
| Facility | | $3,235.94 | $4,466.84 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $5,623.41 / $7,413.10
| Professional | | $3,890.45 | $5,623.41 | $7,413.10 |